Tracheal injury - Revision history

Rossdonaldson1: /* Background */

2021-04-10T13:48:35Z

Background

← Older revision		Revision as of 13:48, 10 April 2021
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	==Background==		==Background==
			[[File:Blausen 0865 TracheaAnatomy.png\|thumb\|Tracheal anatomy.]]
	*Usually occurs at junction of trachea and cricoid cartilage		*Usually occurs at junction of trachea and cricoid cartilage
	*Direct trauma to airway is rare due to protection by sternum and mandible		*Direct trauma to airway is rare due to protection by sternum and mandible

ClaireLewis at 19:53, 13 October 2019

2019-10-13T19:53:43Z

← Older revision		Revision as of 19:53, 13 October 2019
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	==Background==		==Background==
	*Usually occurs at junction of trachea and cricoid cartilage		*Usually occurs at junction of trachea and cricoid cartilage
	*~~direct~~ trauma to airway is rare due to protection by sternum and mandible		*Direct trauma to airway is rare due to protection by sternum and mandible
	*Associated with [[cervical spine injury]], [[head injury]], multisystem trauma		*Associated with [[cervical spine injury]], [[head injury]], multisystem trauma

	===Common causes===		===Common causes===
	*Motor vehicle accident: extended neck impacts on steering wheel or dashboard		*Motor vehicle accident: extended neck impacts on steering wheel or dashboard
	*"~~clothes~~ line injury", assaults/strangulation		*"Clothes line injury", assaults/strangulation
	*Penetrating trauma (usually stabbings or gunshot wounds)		*Penetrating trauma (usually stabbings or gunshot wounds)

	==Clinical Features==		==Clinical Features==
	*[[Respiratory distress[[		*[[Respiratory distress]]
	*Hoarseness, [[dysphonia]], [[cough]], [[stridor]], [[dysphagia]]		*Hoarseness, [[dysphonia]], [[cough]], [[stridor]], [[dysphagia]]
	*Subcutaneous emphysema		*Subcutaneous emphysema

ClaireLewis at 19:53, 13 October 2019

2019-10-13T19:53:12Z

← Older revision		Revision as of 19:53, 13 October 2019
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	==Clinical Features==		==Clinical Features==
	*Respiratory distress		*[[Respiratory distress[[
	*Hoarseness, dysphonia, cough, stridor, dysphagia		*Hoarseness, [[dysphonia]], [[cough]], [[stridor]], [[dysphagia]]
	*Subcutaneous emphysema		*Subcutaneous emphysema
	*Cervical ecchymosis		*Cervical ecchymosis
	*Hemoptysis		*[[Hemoptysis]]
	*Tracheal deviation or abnormal laryngeal contour		*Tracheal deviation or abnormal laryngeal contour

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	*Plain films, CT		*Plain films, CT
	**Air in soft tissues		**Air in soft tissues
	**Pneumomediastinum, pneumothorax		**[[Pneumomediastinum]], [[pneumothorax]]
	**Cervical spine fractures		**[[cervical spine fractures and dislocations\|Cervical spine fractures]]
	**Hematomas, cartilage fractures		**Hematomas, cartilage fractures
	**Evaluate for other injuries		**Evaluate for other injuries
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	*Mobilize specialists/back-up (ENT, cardiothoracics, surgery, anesthesia)		*Mobilize specialists/back-up (ENT, cardiothoracics, surgery, anesthesia)
	*Keep patient breathing spontaneously for as long as possible		*Keep patient breathing spontaneously for as long as possible
	*High-flow O2		*High-flow [[O2]]
	*May by time with nebulized [[~~epinepherine~~]] and IV [[dexamethasone]]		*May by time with nebulized [[epinephrine]] and IV [[dexamethasone]]
	*Anti-reflux medications (e.g. [[ranitidine]], [[metoclopramide]])		*Anti-reflux medications (e.g. [[ranitidine]], [[metoclopramide]])
	*[[~~Glycopyrolate~~]] to reduce secretions		*[[Glycopyrrolate]] to reduce secretions

	===''AIRWAY MANAGEMENT''===		===''AIRWAY MANAGEMENT''===
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	*Inhalational induction/intubation (keep patient breathing spontaneously)		*Inhalational induction/intubation (keep patient breathing spontaneously)
	*Awake tracheostomy		*Awake tracheostomy
	*~~Considure~~ intubating through open wound if transected trachea visible		*Consider intubating through open wound if transected trachea visible

	==Disposition==		==Disposition==
	*Admit		*Admit

	==See Also==		==See Also==
	*[[Thoracic Trauma]]		*[[Thoracic Trauma]]

Rossdonaldson1: /* AIRWAY MANAGEMENT */

2016-09-08T10:24:58Z

AIRWAY MANAGEMENT

← Older revision		Revision as of 10:24, 8 September 2016
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	''Avoid cricoid pressure!''		''Avoid cricoid pressure!''
	*Awake fiberoptic intubation		*Awake fiberoptic intubation
	*Awake direct laryngoscopy/intubation		*Awake direct laryngoscopy/[[intubation]]
	*Inhalational induction/intubation (keep patient breathing spontaneously)		*Inhalational induction/intubation (keep patient breathing spontaneously)
	*Awake tracheostomy		*Awake tracheostomy

Rossdonaldson1: /* While preparing to secure airway */

2016-09-08T10:24:32Z

While preparing to secure airway

← Older revision		Revision as of 10:24, 8 September 2016
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	*Keep patient breathing spontaneously for as long as possible		*Keep patient breathing spontaneously for as long as possible
	*High-flow O2		*High-flow O2
	*May by time with nebulized epinepherine and IV dexamethasone		*May by time with nebulized [[epinepherine]] and IV [[dexamethasone]]
	*Anti-reflux medications (e.g. ranitidine, metoclopramide)		*Anti-reflux medications (e.g. [[ranitidine]], [[metoclopramide]])
	*Glycopyrolate to reduce secretions		*[[Glycopyrolate]] to reduce secretions

	===''AIRWAY MANAGEMENT''===		===''AIRWAY MANAGEMENT''===

Rossdonaldson1: /* Background */

2016-09-08T10:23:53Z

Background

← Older revision		Revision as of 10:23, 8 September 2016
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	*Usually occurs at junction of trachea and cricoid cartilage		*Usually occurs at junction of trachea and cricoid cartilage
	*direct trauma to airway is rare due to protection by sternum and mandible		*direct trauma to airway is rare due to protection by sternum and mandible
	*Common causes:
	**Motor vehicle accident: extended neck impacts on steering wheel or dashboard
	**"clothes line injury", assaults/strangulation
	**Penetrating trauma (usually stabbings or gunshot wounds)
	*Associated with [[cervical spine injury]], [[head injury]], multisystem trauma		*Associated with [[cervical spine injury]], [[head injury]], multisystem trauma

			===Common causes===
			*Motor vehicle accident: extended neck impacts on steering wheel or dashboard
			*"clothes line injury", assaults/strangulation
			*Penetrating trauma (usually stabbings or gunshot wounds)

	==Clinical Features==		==Clinical Features==

ClaireLewis at 17:20, 5 September 2016

2016-09-05T17:20:58Z

← Older revision		Revision as of 17:20, 5 September 2016
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	==Evaluation==		==Evaluation==
	''Investigate only once airway secure''		''Investigate only once airway secure''
	*~~Chest x-ray~~		*Plain films, CT
	*~~CT scan (neck/c-spine~~, ~~chest), lateral c-~~spine ~~x ray~~, ~~ultrasound~~		**Air in soft tissues
	*Evaluate for other injuries		**Pneumomediastinum, pneumothorax
			**Cervical spine fractures
			**Hematomas, cartilage fractures
			**Evaluate for other injuries

	==Management==		==Management==
	==While preparing to secure airway:		===While preparing to secure airway===
	*Mobilize specialists/back-up (ENT, cardiothoracics, surgery, anesthesia)		*Mobilize specialists/back-up (ENT, cardiothoracics, surgery, anesthesia)
	*Keep patient breathing spontaneously for as long as possible		*Keep patient breathing spontaneously for as long as possible
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	*May by time with nebulized epinepherine and IV dexamethasone		*May by time with nebulized epinepherine and IV dexamethasone
	*Anti-reflux medications (e.g. ranitidine, metoclopramide)		*Anti-reflux medications (e.g. ranitidine, metoclopramide)
	*~~glycopyrolate~~ to reduce secretions		*Glycopyrolate to reduce secretions

	===''AIRWAY MANAGEMENT''===		===''AIRWAY MANAGEMENT''===
			''Avoid cricoid pressure!''
	*Awake fiberoptic intubation		*Awake fiberoptic intubation
	*Awake direct laryngoscopy/intubation		*Awake direct laryngoscopy/intubation
	*Inhalational induction/intubation (keep patient breathing spontaneously)		*Inhalational induction/intubation (keep patient breathing spontaneously)
	*Awake tracheostomy		*Awake tracheostomy
	*Considure ~~itubating~~ through open wound if transected ~~tracea~~ visible		*Considure intubating through open wound if transected trachea visible

	==Disposition==		==Disposition==
			*Admit
	==See Also==		==See Also==
	*[[Thoracic Trauma]]		*[[Thoracic Trauma]]

ClaireLewis: /* Management */

2016-09-05T17:16:26Z

Management

← Older revision		Revision as of 17:16, 5 September 2016
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	==Management==		==Management==
			==While preparing to secure airway:
			*Mobilize specialists/back-up (ENT, cardiothoracics, surgery, anesthesia)
			*Keep patient breathing spontaneously for as long as possible
			*High-flow O2
			*May by time with nebulized epinepherine and IV dexamethasone
			*Anti-reflux medications (e.g. ranitidine, metoclopramide)
			*glycopyrolate to reduce secretions

			===''AIRWAY MANAGEMENT''===
			*Awake fiberoptic intubation
			*Awake direct laryngoscopy/intubation
			*Inhalational induction/intubation (keep patient breathing spontaneously)
			*Awake tracheostomy
			*Considure itubating through open wound if transected tracea visible

	==Disposition==		==Disposition==

ClaireLewis: /* Evaluation */

2016-09-05T17:08:31Z

Evaluation

← Older revision		Revision as of 17:08, 5 September 2016
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	==Evaluation==		==Evaluation==
			''Investigate only once airway secure''
			*Chest x-ray
			*CT scan (neck/c-spine, chest), lateral c-spine x ray, ultrasound
			*Evaluate for other injuries

	==Management==		==Management==

ClaireLewis: /* Clinical Features */

2016-09-05T17:05:24Z

Clinical Features

← Older revision		Revision as of 17:05, 5 September 2016
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	==Clinical Features==		==Clinical Features==
	*Subcutaneous emphysema~~, stridor~~		*Respiratory distress
			*Hoarseness, dysphonia, cough, stridor, dysphagia
			*Subcutaneous emphysema
			*Cervical ecchymosis
			*Hemoptysis
			*Tracheal deviation or abnormal laryngeal contour

	==Differential Diagnosis==		==Differential Diagnosis==